Cigna Collaborative Accountable Care

Transcription

1 Cigna Collaborative Accountable Care Health Industry Forum Dick Salmon, MD, PhD National Medical Director Copyright 2012 by Cigna.

2 NETWORK STRATEGY Achieve the triple aim = better quality, better cost, better health care experience Traditional network management Pay the right amount, for the right service at the right level of care: National initiatives Market-specific initiatives Value-based network benefits Incentivize customers to make the right health care professional choice: Narrow networks Tiered networks Value-based reimbursement Collaborate with and reward health care professionals: Align financial incentives Augment health coaching capacity Provide actionable information Three pillars of network strategy Implemented on a market-specific basis 2

3 Our VBCR Vision: 80/80 Our Goal* 80% of customers driving 80% of costs will be treated by health care professionals with incentive and assistance to achieve the triple aim Our VBCR Initiatives 1. Collaborative Accountable Care (Reward large HCP groups for achieving the triple aim for care of their virtually aligned population). 2. Patient Care Collaboration (Reward individual HCPs for each specific act of care coordination which reduces hospital readmissions, chronic disease admissions; and improves appropriate site of service (steerage)) 3. Specialty Care Incentive Programs (Reward large specialty groups for steerage, guideline adherence, or episode cost control. Will focus on top 5 specialties cost drivers; OBGYN, Ortho, Gastro, Cardio and Oncology). 4. Hospital Incentive Programs (Rewards hospital for improving quality and care coordination using a care coordination fee) *Additional criteria to drive decisions include TMC save; customer, client, and HCP engagement and penetration; and new business sales and retention 3

4 EVOLUTION OF COLLABORATIVE ACCOUNTABLE CARE Patient-Centered Medical Home Reward for NCQA recognition Accountable Care Organization Rewards for health outcomes Cigna Collaborative Accountable Care Aligned financial incentives Actionable information Clinical integration 4

5 WORKING BETTER TOGETHER FOR BETTER RESULTS Physician/Hospital Group Resources WORKING TOGETHER FOR BETTER RESULTS COLLABORATION EMBEDDED CARE COORDINATORS Individual Cigna Solutions Patient-centered care Personal care Coordinated care Better engagement Better health Better cost Better satisfaction INFORMATION Improving the way we share actionable information through technology to better identify health and cost improvement opportunities. CLINICAL INTEGRATION Enhancing outreach efforts by coordinating staffing resources to more effectively engage individuals in available health improvement programs. A key element of this integration is the embedded care coordinator. INCENTIVES Providing rewards to physicians and hospitals that deliver the greatest positive impact on our customers health. 5

6 Total Medical Cost (PPPM) COLLABORATIVE ACCOUNTABLE CARE PAYMENT* Must pass elements compared to market: Quality: Evidence-Based Measures (EBM) and patient satisfaction improved or maintained at better than market average in order to be eligible for gain-share Affordability: per capita medical cost trend better than market average Initial Care Coordination Payment based on a portion of anticipated savings of year 1 action plan Risk-adjusted Expected Trend Gain-share Actual Trend PPPM Improvement A portion is the potential adjustment to the care coordination payment If trend worsens in year 2 or beyond, the Care Coordination payment is reduced Year 1 Year 2 Year 3 *In addition to standard fee-for-service payments 6

7 ACTUAL POTENTIAL CRITERIA FOR CAC PARTNERS MISSION AND LEADERSHIP Mission is increasing value- transitioning from maximizing reimbursement per service and volume of service to maximizing value and the volume of population served Strong C-suite and CMO leadership CULTURE Strong foundation of primary care, population based care Internal reimbursement/incentives around value, not volume; team work, not solo performance CAPABILITY Market leading reputation for primary care, most specialists and broad hospital services Primary care capacity Record of commitment to population care: meaningful use of Electronic Health Record system, NCQA Patient Centered Medical Home Recognition obtained or in progress Track record of meaningful improvement in population based care PARTNERSHIP COMMITMENT Willingness to make significant investment Willingness to commit to significant long-term arrangement Willingness to integrate with Cigna sponsored on-site clinics SIZE Capability of serving at least 10% of the market SIGNIFICANT, BELIEVABLE ACTION PLAN FINANCIAL COMMITMENT Review performance reports for opportunity Clear TMC action plan : Significant and believable Either no initial care coordination payment or payment at risk Additional risk impact on underlying FFS agreement, target is MCOL rather than market trend Multi-year base contract in place; clear impact on treating physician take home pay 7

8 6/13/2012 v2.0 Active 1+ years (8) Active <1 years (24) Benefit incentive available 2012 Pipeline (31) Unnoted Prospects (44) CIGNA COLLABORATIVE ACCOUNTABLE CARE INITIATIVES DEMOGRAPHICS: Active Initiatives 32 States 16 PCPs 4,500+ Specialists 5,500+ Customers 330k+ ACTIVE INITIATIVES: NH, Dartmouth-Hitchcock Clinic (6/08) TX, Medical Clinic of North Texas (8/09) CT, ProHealth Physicians, Inc. (10/09) ME, Eastern Maine Healthcare Systems (1/10) GA, Piedmont Physicians Group (6/10) MO, Mercy Clinic (7/10) TN, Holston Medical Group (8/10) TN, Health Choice (8/11) NJ, Partners In Care (10/11) NY, Weill Cornell Physician Organization (10/11) TN, The Jackson Clinic (1/12) ME, Penobscot Community Health Center (1/12) ME, Kennebec Region Health Alliance (2/12) VA, Bon Secours Medical Group (3/12) VA, Fairfax Family Practice Centers (3/12) NY, WESTMED (3/12) CO, Colorado Springs Health Partners (4/12) NC, Cornerstone Health Care (4/12) NC, Key Physicians (4/12) TX, HealthTexas Provider Network (4/12) ME, InterMed (4/12) ME, Martin s Point Health Care (4/12) CA, Palo Alto Medical Foundation (7/1) CO, New West Physicians (7/12) NH, Granite Healthcare Network (7/12) ME, Mercy Hospital (7/12) OH, Mount Carmel Health Partners (7/12) TX, St. Luke s Episcopal Hospital IPA (7/12) TX, Renaissance Physician Organization (7/12) VT, Fletcher Allen Health Care (7/12) BENEFIT INCENTIVE AVAILABLE (current): AZ, Cigna Medical Group (1/10) TX, Kelsey-Seybold (6/11) 8

9 DARTMOUTH-HITCHCOCK DELIVERING IMPROVED QUALITY Cigna patients in Dartmouth Medical Home vs. private practice without care coordination: Results 10.4% 13.8% 16% 8.1% improvement in overall gaps-incare closure rates greater closure rate for highpriority gaps greater closure rate for hypertension gaps greater closure rate for diabetes gaps Information + Integration + Incentives = Improved Results Information + Integration + Incentives = Improved Results 9

10 MEDICAL CLINIC OF NORTH TEXAS ACHIEVING QUALITY AND COST IMPROVEMENTS 2 Year Results 3% 7% 2% 6.3% 2% improvement in control of blood sugar levels in diabetic patients better than market Emergency Room avoidable visit rate decline in hospital readmission rate better than market adherence to evidencebased medicine lower than market medical cost trend Information + Integration + Incentives = Improved Results 10

11 CIGNA MEDICAL GROUP DELIVERING BETTER HEALTH Comparison of Cigna patients in CMG vs. private practice Better Quality 3% -11% 3% 12% Increase in overall preventive care visits Increase in adult preventive care visits Lower Total Medical Costs 7% Reduction in ambulatory surgical utilization and cost Information + Integration + Incentives = Improved Results 11

12 REWARD SPECTRUM Option I Reward through increased Care Coordination Payment for achieving the triple aim Option II Reward through increased patient volume resulting from tiered network product Option III Reward through increased patient volume resulting from customized network 12

13 Cigna is a registered service mark, and the Tree of Life logo and GO YOU are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models are used for illustrative purposes only a 03/ Cigna. Some content provided under license.